Postoperative electrolyte disorders

doi:10.1017/CBO9780511544590.028

25 - Postoperative electrolyte disorders

Published online by Cambridge University Press: 12 January 2010

Juliet Kottak Mavromatis

Edited by

Nathan O. Spell and

Juliet Kottak Mavromatis: Affiliation:
Emory University, School of Medicine, Atlanta, GA
Michael F. Lubin: Affiliation:
Emory University, Atlanta
Robert B. Smith: Affiliation:
Emory University, Atlanta
Thomas F. Dodson: Affiliation:
Emory University, Atlanta
Nathan O. Spell: Affiliation:
Emory University, Atlanta
H. Kenneth Walker: Affiliation:
Emory University, Atlanta

Book contents

Get access

Summary

A variety of electrolyte disorders are common postoperatively. These result from fluid losses, intravenous fluid administration, and intrinsic regulatory mechanisms that come into play at this time. During surgery, large volumes of isotonic fluids as well as blood products may be given to compensate for the blood loss and third spacing that occurs with the surgical procedure. In the postoperative period patients must remain fasting until bowel function has returned. Frequently, nasogastric, chest, or biliary tubes are present and drain fluids and maintenance intravenous fluids are continued. Parenteral nutrition often complicates fluid balance. There may be shifts in acid–base status such as metabolic acidosis from lactic acidosis secondary to tissue ischemia, or respiratory alkalosis from hyperventilation as a result of pain or mechanical ventilation. Anesthetics, diuretics, steroids, insulin, cardiac medications, and non-steroidal anti-inflammatory drugs administered during this time period may alter plasma electrolytes and further complicate the picture.

Sodium disorders

Abnormalities of serum sodium are generally disorders of water balance. Hyponatremia occurs when there is too much free water, which may be retained appropriately or inappropriately. Hypernatremia occurs in patients who have an impaired thirst mechanism or have limited access to water and are not repleted appropriately. Of the two, hyponatremia is generally more common as a postoperative problem.

Hyponatremia

In order to understand sodium and water disorders one must understand the relationship between plasma sodium concentration and serum osmolality.

Type: Chapter
Information: Medical Management of the Surgical Patient
A Textbook of Perioperative Medicine
, pp. 353 - 360

DOI: https://doi.org/10.1017/CBO9780511544590.028 [Opens in a new window]

Publisher: Cambridge University Press

Print publication year: 2006

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Book purchase

Temporarily unavailable

References

Androgue, H. J. & Madias, N. E.Primary care: hyponatremia. N. Engl. J. Med. 2000; 342: 1581–1589.CrossRef Google Scholar

Agarwal, R. & Emmett, M.The post-transurethral resection of prostate syndrome: therapeutic proposals. Am. J. Kidney Dis. 1994; 24: 108–111.CrossRef Google Scholar PubMed

Gowrishankar, M., Lin, S.-H., Oh, M. S., & Halperin, M. L.Acute hyponatremia in the perioperative period: insights into its pathophysiology and recommendations for management. Clin. Nephrol. 1998; 50: 352–360.Google Scholar PubMed

Rose, B. D. & Post, T. W.Clinical Physiology of Acid–Base and Electrolyte Disorders. New York: McGraw-Hill, 2001.Google Scholar

Chung, H.-M., Kluge, R., Schrier, R. W., & Anderson, R. J.Postoperative hyponatremia: a prospective study. Arch. Int. Med. 1986; 146: 333–336.CrossRef Google Scholar PubMed

Steele, A., Gowrishankar, M., Abrahamson, S., Mazer, C. D.et al. Postoperative hyponatremia despite near-isotonic saline infusion: a phenomenon of desalination. Ann. Int. Med. 1997; 126: 20–25.CrossRef Google Scholar PubMed

Arieff, A. I.Hyponatremia, convulsions, respiratory arrest, and permanent brain damage after elective surgery in healthy women. N. Engl. J. Med. 1986; 314: 1529–1534.CrossRef Google Scholar PubMed

Ayus, C., Wheeler, J. M., & Arieff, A. I.Postoperative hyponatremic encephalopathy in menstruant women. Ann. Int. Med. 1992; 117: 891–897.CrossRef Google Scholar PubMed

Laureno, R. & Karp, B. I.Myelinolysis after correction of hyponatremia. Ann. Int. Med. 1997; 126: 57–62.CrossRef Google Scholar PubMed

Sterns, R. H., Riggs, J. E., & Schochet, S. S.Osmotic demyelination syndrome following correction of hyponatremia. N. Engl. J. Med. 1986; 314: 1535–1541.CrossRef Google Scholar PubMed

Palevsky, P. M., Bhargrath, R., & Greenberg, A.Hypernatremia in hospitalized patients. Ann. Int. Med. 1996; 124: 197–203.CrossRef Google Scholar PubMed

Andrews, B. T.Fluid and electrolyte disorders in neurosurgical intensive care. Neurosurg. Clin. North Am. 1994; 5: 707–721.Google Scholar PubMed

Androgue, H. J. & Madias, N. E.Primary care: hypernatremia. N. Engl. J. Med. 2000; 342: 1493–1499.CrossRef Google Scholar

Sterns, T. H., Spital, A., & Clark, E. C. Disorders of water balance. In Kokko, J. P. & Tannen, R. L., eds. Fluids and Electrolytes. Philadelphia: W. B. Saunders, 1996.Google Scholar

Lutarewych, M. A. & Battle, D. C. Disorders of potassium balance. In Androgue, H. J., ed. Contemporary Management in Critical Care: Acid–Base and Electrolyte Disorders. New York: Churchill Livingstone, 1991.Google Scholar

Tannen, R. L. Potassium disorders. In Kokko, J. P. & Tannen, R. L., eds. Fluids and Electrolytes. Philadelphia: W. B. Saunders, 1996.Google Scholar

Rimmer, J. M., Horn, J. F., & Gennari, J.Hyperkalemia as a complication of drug therapy. Arch. Int. Med. 1987; 147: 867–869.CrossRef Google Scholar PubMed

Toto, R. D. & Alpern, R. J. Metabolic alkalosis. In Androgue, H. J., ed. Contemporary Management in Critical Care: Acid–Base and Electrolyte Disorders. New York: Churchill Livingstone, 1991.Google Scholar

Wilson, R. F., Bibson, D., Percinel, A. K.et al. Severe alkalosis in critically ill surgical patients. Arch. Surg. 1972; 105: 197.CrossRef Google Scholar PubMed

McDougal, W. S.Metablic complications of urinary intestinal diversion. J. Urol. 1992; 147: 1199–1208.CrossRef Google Scholar

Batlle, et al. Urinary anion gap and metabolic acidosis. N. Engl. J. Med. 1988; 318: 594–599.CrossRef Google Scholar PubMed

Toto, R. D. & Alpern, R. J. Metabolic acid–base disorders. In Kokko, J. P. & Tannen, R. L., eds. Fluids and Electrolytes. Philadelphia: W. B. Saunders, 1996.Google Scholar

Hood, V. L. & Tannen, R. L. Lactic acidosis. In Androgue, H. J., ed. Contemporary Management in Critical Care: Acid–Base and Electrolyte Disorders. New York: Churchill Livingstone, 1991.Google Scholar

Androgue, H. J. & Maliha, G. Diabetic ketoacidosis. In Androgue, H. J., ed. Contemporary Management in Critical Care: Acid–Base and Electrolyte Disorders. New York: Churchill Livingstone, 1991.Google Scholar

Cooper, D. J., Walley, K. R., Wiggs, B. R., & Russell, J. A.Bicarbonate does not improve hemodynamics in critically ill patients who have lactic acidosis. A prospective, controlled clinical study. Ann. Intern. Med. 1990; 112: 492–498.CrossRef Google Scholar

Lever, E. & Jaspan, J. B.Sodium bicarbonate therapy in severe diabetic ketoacidosis. Am. J. Med. 1983; 75: 263–268.CrossRef Google Scholar PubMed

Singer, G. G. & Brenner, B. M. Fluid and electrolyte disturbances. In Braunwald, E., Fauci, A. S., Kasper, D. L., Hauser, S. L., Longo, D. L., & Jameson, J. L., eds. Harrison's Principles of Internal Medicine, 15th edn. New York: McGraw-Hill, 2001.Google Scholar